Mild Clinical Presentation of Acute Fatty Liver in the Second Trimester of Pregnancy

Abstract

We report a case of 29 years old woman who was diagnosed with acute fatty liver of pregnancy at 23 weeks of gestation with unusual evolution (pregnancy prolonged until 36 weeks of gestation) to draw attention on the possibility of occurrence of this pathology in the second trimester of pregnancy even with a milder clinical presentation and course.

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

“…AFLP usually manifests during late third trimester at a mean of 36 weeks, 1,5 and up to 9.8% in the immediate postpartum period 26 . Nonetheless, several cases were identified during second trimester, 6,18,27–33 but interestingly, it has never been reported in first trimester 2 . Potential clinical risk factors include prior episode of AFLP in a previous pregnancy, 34 multiple gestations, 35 underweight (BMI of ≤20), 3 nulliparity 8 and carrying a male fetus 36 .…”

“…AFLP tends to deteriorate with time, with progressive infiltration of hepatocytes, beside the high probability of other organs involvement and consequent devastating outcome unless immediate termination of pregnancy takes place 3 . The only exception to this scenario was described in 2011 by Yassin et al who elected to follow expectantly a woman with mild AFLP presenting at 23 weeks' gestation and showing clinical and laboratory stability 31 . The diagnosis was confirmed with liver biopsy.…”

“…A search was performed in the PubMed and Google Scholar database for cases contracting AFLP before third trimester. We could identify nine compatible cases published in the English language with complete account of details (beside current case) 6,18,27–33 . Cases that were reported as a part of case series but lacking detailed description of individual patients were hence excluded from this review 3,26 (Table 1).…”

“…This previously compelled care givers to resort to perform liver biopsy in order to clarify the identity of the disease before indulging in termination of pregnancy. Expectant management was successful only in one case, 31 but was abandoned in remaining 5 of 6 cases upon the development of serious complications such as IUFD, pulmonary edema, respiratory failure and DIC 6,18,27–29 . All cases manifested the illness antepartum and liver biopsy was used to confirm diagnosis in 6 of 10 cases (60%), while in recent more case series, liver biopsy was seldom used to make the diagnosis 3,26 .…”

“… †Pooled rates of 10 cases with early AFLP (<28 weeks) 6,18,27–33 including current case compared to pooled rates of 513 case from 12 case series of late AFLP (≥28 weeks) 3,7,13,14,19,20,26,34,39,43,46,47 …”